Provider Demographics
NPI:1659910750
Name:CHIPPENDALE, DOROTHY (LMFT, LCADC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:CHIPPENDALE
Suffix:
Gender:F
Credentials:LMFT, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 ELM PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1916
Mailing Address - Country:US
Mailing Address - Phone:732-670-8228
Mailing Address - Fax:732-961-1125
Practice Address - Street 1:501 PROSPECT ST BLDG 1A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5026
Practice Address - Country:US
Practice Address - Phone:732-961-9666
Practice Address - Fax:732-961-1125
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NJ37LC00185700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00185700OtherLICENSE NUMBER